Fillable Application for Adults and Children with Long Term Care Needs

Description

State of Alaska Department of Health and Social Services Division of Public Assistance If known, please provide the following information: name of agency or nursing home name of care coord./ social worker Application for Adults and Children with Long Term Care Needs Please check the services you need: Home and Community-Based Services Medicaid Waiver (a.k.a. CHOICE) phone fax Child with Disabilities Nursing